CIPN Case Study

Ms. Bynum is a self-referral who agreed to participate in the TPAPN monitoring program. On 11/24/16, Ms. Bynum tested positive for alcohol (ETG - 2510 ng/ml, ETS - 77 ng/ml) and renewed her program with TPAPN. On 2/26/16, Ms. Bynum tested positive for alcohol (ETG - 7980 ng/ml, ETS - 1580 ng/ml). On 4/7/16, Dr. John Lehman conducted an assessment on Ms. Bynum and recommended 90-day inpatient treatment program that Ms. Bynum refused. Additionally, Dr. Lehman stated on assessment that Ms. Bynum is not fit to practice and has a high-risk for relapse.

To better understand your condition, can you kindly provide brief descriptions of the various symptoms that you are experiencing?

At this point, coordination is at a point where falls are often major risks, and considering many cases of the disease occur in the elderly, this can become a fatal risk. Close relatives are soon to become unrecognizable and the long term memory of the individual begins to fade as the disease worsens. It is often that at this point of the disease, the patient is put into a care center, as they may become a burden to the family members around them. Emotions swing and become entirely unpredictable and often resistance to care will occur as the patients lose awareness of their condition and become confused with their surroundings.

Pain is one of the most common and feared complications of cancer. It is exacerbated by stress, anxiety, fatigue, and malaise which accompany advanced cancer. Pain is generally absent in the early stages of cancer, but it is a significant factor as the illness progresses to advanced stages. Cancer-associated pain can arise from a variety of direct and indirect mechanisms including direct pressure, obstruction, and invasion of a sensitive structure, stretching of visceral surfaces, tissue destruction, infection, and inflammation (McCance 2010). Pain is generally accepted as whatever the patient says it is, wherever the patient says it is. Treatment of pain and its associated symptoms is a primary responsibility of the healthcare team. Treatment modalities for pain include the use of opioid analgesics, patient-controlled analgesia, psychological interventions, and preventing recurrence of pain. Reinforcing the reporting of pain by the patient is important, as is a respect for the social and cultural differences with respect to pain perception.

The complication is that many of the symptoms associated to this illness can be confused with a number of other conditions early on.

A behavioral health physician statement completed by Victorino De Jesus, MD (Internal Medicine), dated 05/10/2017, indicated that the claimant was incapacitated for a single continuous period of time due to her medical condition, including any time for treatment and recovery from 05/09/2017 - 07/09/2017. The claimant had impaired concentration and train of thought that affect work performance. She also had osteoarthritis of the bilateral elbow, hands, fingers, and feet.

Blood pressure -138/88, HR 71, Lung sounds –clear, temperature 98.8 F, radial pulse and pedal pulses +1 bi-laterally, normoactive bowel sounds. No history of smoking, drugs, alcohol use or diabetes; takes no daily medications. Surgical history: Hernia surgery September 2016 and cataract surgery September 2013. Moderately active, walks every day, sometime incorporating hand weights. Patient presents with minimal trembling unilaterally, (left side) when fingers stretched out, reports movements have been slower than normal. Patient’s wife reports “He’s been eating more slowly and it has been taking longer for him to get dressed in the morning.”. Upon examination it was determined that patient has reduced arm swing, slight stiffness in neck, difficulty rising from sitting position in the chair, masked facial features and deteriorated balance. No signs or symptoms of stroke.

The CIN infrastructure serves as FCHA’s collaboration vehicle for improving care and delivering value, as well as positions the organization to enter into accountable care organization (ACO) contractual arrangements. The FCHA ACO, which fosters greater collaboration by using a value-based compensation model to reward providers for improved outcomes and reduced costs, was selected to participate in the Centers for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program (MSSP) to share in cost savings they achieve for Medicare

The main concern of Mrs R is chronic pain related to bone pain due to bone cancer with metastatic cancer in the liver as evidenced by the presence of verbal and behavioural indicators of pain such as anxiety, concerns and tension, grimacing, complaints when ambulating with a walker and a pain level of 8/10 at 8:00am.

Pain, which is defined in its widest sense as an emotion which is the opposite of pleasure (White, 2004, p.455), is one of the major symptoms of cancer, affecting a majority of sufferers at some point during their condition (De Conno & Caraceni, 1996, p.8). The World Health Organization (WHO, 2009, online) suggests that relief from pain may be achieved in more than 90 percent of patients;

Leukemia most common treatments are: Chemotherapy, Radiation therapy, and Bone marrow transplantation, and then there is also Biological therapy. In chemotherapy, patients take one or more anticancer drugs by mouth or, intravenously through IV therapy. In some cases, doctors need to inject the drugs directly into the fluid that surrounds the brain and spinal cord. Chemo can cause side effects, like losing your hair, nausea, fatigue, or easy bruising, depending on the drug. The side effects usually go away progressively between treatments or after treatments stop.

In the clinical setting, it would be advantageous to facilitate the use of a self-administered neurotoxicity portion of the FACT/GOG questionnaire. The at risk chemotherapy patient could complete it upon arrival to the infusion center. This could be followed by performing the abbreviated TNSc, which would consist of a

Overview of the Problem: A number of cancer survivors has been growing tremendously and pain management became a priority in cancer treatment. According The American Cancer Society (2016), in 2026 the population of cancer survivors in the US will increase to 20.3 million in compare to 15.5 million people in 2016 (American Cancer Society, 2016). The most common cancer in men are prostate tumors account for about 1/5 of cancers in men( 21%), subsequently lung and bronchus (14%), colon and rectum cancer (8 %), and bladder carcinomas (7%). Among the ten most common cancers in men, there are also melanoma, kidney, leukemia and lymphomas and larynx. Among women, breast cancer is representing about 1/3 of cancers (29%). Lung and bronchus are

Chemotherapy is given in cycles a treatment period followed by a recovery period, then another treatment period and so on. The drug enters the blood stream and destroys leukemia cells throughout the body. However, they cannot reach the brain and spinal cord, because of a protective network of blood vessels that keep foreign substances from entering the central nervous system. In certain cases doctors need to inject the drug directly into the fluid that surrounds the brain and spinal cord. (Health a to z, 20)

Patient also, has history of hypertension, GERD, morbid obesity, anemia, and depression. She reported that the past few months, she has been feeling very weak and overall generalized deconditioning. Her ability to care for herself including her activities of daily living (ADLs), and her basic physical needs (like bathing, grooming, ambulation, meal preparation, transportation, errands, and housekeeping), had decreased, and cannot consistently carry them out.